Disclaimer: This document does not constitute legal advice. It is merely intended to be a starting point regarding your right to complain.

What do we do when obstetricians or other hospital staff treated us rudely, abusively or violently? Do they ever hear from us afterward? Abusive behavior toward women, especially in childbirth, is unacceptable and harmful (can cause Post Traumatic Stress Syndrome). Abusive or unacceptable behavior can include threats, scolding, coercion, yelling, belittling, lying, manipulating, mocking, dismissing, refusing to acknowledge, treating without informed consent, omission of information, over-riding your refusal of a treatment, misrepresentation (of medical situation, of interventions, of reasons they “need” you to do something or not do something), etc. For a raised consciousness on this topic, read: Violence against women in health-care institutions: an emerging problem. by A. F.P.L. d’Oliveira, S.G. Diniz and L. B. Schraiber The Lancet, Vol. 359. May 11, 2002.

The idea is not to complain about things just for the sake of complaining or just to be nitpicking (for example, if overall the care was very good, but one person under unusual circumstances was less than satisfactory, a friendly, informative note to that one person might be more effective than a full-blown complaint). The idea is to put the provider and the Medical Board on notice that these kinds of behaviors are serious and harmful, especially a pattern of them, and are not acceptable even if there have been few complaints in the past. While single complaints probably will be ignored, I think if enough women actually formally complained about abusive treatment of any kind and asked for changes, the medical establishment would have to start listening. Also, by sending copies of the complaint to other potentially interested individuals and organizations, the complaint can also serve an educational and consciousness-raising purpose for more women. Here are steps you can take:

1. Write (handwritten is best) a narrative report of everything you remember from the situation – with dates, what people said and did (including as much as possible names of anyone involved, dates and times), etc., and sign and date that narrative. The sooner you write all of it down, the better. Such a dated, personal, written narrative will stand as evidence in a court of law. Even better, have your statement notarized by a notary public, which will establish the date by which you wrote the statement. Your narrative (and those of others, see #2) help establish the facts and keep your memory fresh. They would be especially useful IF your complaint eventually resulted in some kind of formal hearing or legal action; it may be that you don’t use the narratives at all, but if you need them later, you will wish you had taken this step. Your dated, notarized first-person written account is much stronger than someone else’s memory months or years later.

2. If you can get anyone else who witnessed the behavior(s) to write a narrative describing the same incidents, that would be very valuable. For example, is there a nurse who would do that? Did your husband, a friend, or a doula come to any of your office visits or to the birth, where incidents occurred? Did you complain to family members or to a friend right after one of these run-ins with the doctor? Ask those people to write down in detail what they heard and saw, or they heard you say at the time and how you were acting (ie, upset? in tears? etc.). DO NOT coach them on what to write. Each one should also date and sign their narrative, and mention that this was their personal experience and memory of the events.

3. Filing a formal complaint:

Use the Internet or get help from a library to find a website or contact information for your State Medical Board (name may vary). This website has direct links to EVERY state''s medical board website. Each of the Medical Board home pages I looked at had something for “consumers” or “complaints” or “patients rights” leading to information on how to file a complaint. (For other medical staff or the hospital itself, you may have to complain to another board, and use their complaint procedure, state statute, etc. depending on your state.) Every state has a procedure for filing a complaint about a physician; for most states information about how to do this is on-line. If the formal complaint process does not allow for attaching statements (a copy of your dated narrative or those of others), you can at least mention in the complaint that you have these statements.

Look up your state’s Medical Practice Act and locate the section that describes "unprofessional conduct" – the behavior you are complaining about is likely to fall into this category, and it is more powerful if you can cite the section of the statute. A public library librarian should be able to help you, or your local legislator.

Download ACOG''s (American College of Obstetricians & Gynecologists) ethics statement from the ACOG website,www.acog.org (search for “ethics” on the ACOG website and you will get the .pdf file of this statement to print out). It is actually pretty good, except that it is ignored. The ACOG ethics statement is not legally binding unless specifically referred to in your state statute; however, this document constitutes the professional guidelines for OBs and again, you can strengthen your complaint by pointing out (quoting from it) the ways the OB violated the profession''s standard for ethical practice.

ACOG has separate statements regarding informed consent (also available on their website) and informed refusal (see below). Many abuses and unnecessary interventions are associated with a lack of or inadequate informed consent process, or the refusal of the physician or staff to honor your informed refusal of treatment.

Using all this material (quotes are good!) and the formal complaint procedure, write the formal complaint and keep copies.

You should include what you want the Medical Board to do that is realistic within their authority per the statute (such as reprimand the physician? Have the physician make a formal written apology to you? Require the physician to get sensitivity training? Etc.)

You can also use this general process to file complaints about any other health care providers or a hospital to their respective state boards.

4. Compose a cover letter explaining briefly why you were moved to complain – ie, you felt so outraged, betrayed, violated, abused, damaged etc. by the doctor''s behavior etc. and how the experience affected you (rage? Loss of confidence? Distraction? Sleeplessness? Post traumatic stress syndrome?) – with cc''s indicated for all the other places and people to whom you decide to send the letter (see #5). Include again what you want to come from this complaint (what you want the Medical Board to do, etc.). You might want to have one or two other people review your draft and make suggestions for your letter and complaint to be as clear and effective as possible. Send that cover letter with the formal complaint to the Medical Board by “certified mail return receipt requested,” so you have proof that they received the complaint (also, it makes them take it more seriously).

5. Make copies of your formal complaint and send it (regular mail is OK) with a cover letter (vary the cover letter as needed for the various audiences) to as many other individuals and organizations as you want. For at least some of these, you might want to include a specific request for action on their part, as appropriate. Suggested individuals and organizations:

Your HMO or Insurance Company

Your State Insurance Commissioner (if insurance coverage is an issue)

The Hospital Board (as a whole, or each individual member)

Public Relations person, consumer relations person, etc. at the hospital

Any appropriate midwifery board (for CNMs and/or licensed midwives)

Any women’s organizations, local and/or state, such as NOW Chapter, groups working on prevention of violence against women, rape prevention, etc.

An attorney – this can be a friend or any attorney who agrees to be listed; you just want the Medical Board and others to see that you are talking with an attorney. This may be more important for some situations than for others.

National organizations like ICAN and Citizens for Midwifery,www.cfmidwifery.org .

By sending your complaint to a whole array of people, lots of people know about it, and it is less likely to be ignored. You are also educating women''s groups and others about abuse against pregnant women and in childbirth. If nothing comes of your complaint, you will at least have documentation to use to take any further actions you may feel moved to take (writing to the newspaper, writing an article for a women''s magazine, etc.). If you have a means of collecting such complaints locally, that might give impetus for collective action locally regarding a specific physician or hospital, or targeting hospital policies.

6. Follow up! Bug the Medical Board until you get a response. Follow up with the hospital people. If you are unhappy about the response you get, let them know, let your State Representative know what is going on, tell the hospital people that you are dissatisfied and may take further steps. Depending on the original situation, you can consider a number of possibilities, from consulting with an attorney, to writing an article for the local paper or a Letter to the Editor, to speaking to womens’ groups in your town, to deciding to let it go.

Filing a formal complaint is NOT guaranteed to "fix" the situation. However, if enough of us complain, it should get others thinking about changes in the future.

American College of Obstetricians & Gynecologists Ethical Dimensions of Informed Consent in Ethics in Obstetrics and Gynecology 2002

American College of Obstetricians & Gynecologists. ACOG Informed refusal. Committee Opinion No 237, June 2000. Not available electronically. Reads in part: "Once a patient has been informed of the material risks and benefits involved with a treatment, test, or procedure, that patient has the right to exercise full autonomy in deciding whether to undergo the treatment, test, or procedure or whether to make a choice among a variety of treatments, tests, or procedures. In the exercise of that autonomy, the informed patient also has the right to refuse to undergo any of these treatments, tests, or procedures. . . . Performing an operative procedure on a patient without the patient''s permission can constitute ''battery'' under common law. In most circumstances this is a criminal act. . . . Such a refusal [of consent] may be based on religious beliefs, personal preference, or comfort.” [In other words, women don''t have to have what an obstetrician would consider a good reason. All they have to do is decline.]

About the author: Susan Hodges, a birth activist for more than 15 years, is President of Citizens for Midwifery, a consumer-based organization promoting the Midwives Model of Care and representing consumer interests regarding midwifery and maternity care. Find out more about Citizens for Midwifery at their website: www.cfmidwifery.org.